Neuropediatrics 2021; 52(04): 333-336
DOI: 10.1055/s-0041-1725013
Short Communication

Vitamin B12 Deficiency and West Syndrome: An Uncommon but Preventable Cause of Neurological Disorder. Report on Three Cases, One of Them with Late Onset during Vitamin B12 Treatment

1   Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
,
Federica Sullo
1   Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
,
Raffaele Falsaperla
2   Neonatal Intensive Care, AUO San Marco-Policlinico, University of Catania, Catania, Italy
,
Filippo Greco
1   Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
,
Agustina Crespo
3   Department of Neurology, Hospital de Pediatría “Prof. Dr. Juan P Garrahan” Buenos Aires, Buenos Aires, Argentina
,
Agustin Calvo
3   Department of Neurology, Hospital de Pediatría “Prof. Dr. Juan P Garrahan” Buenos Aires, Buenos Aires, Argentina
,
Roberto Caraballo
3   Department of Neurology, Hospital de Pediatría “Prof. Dr. Juan P Garrahan” Buenos Aires, Buenos Aires, Argentina
› Author Affiliations

Abstract

Vitamin B12 is a water-soluble vitamin that plays a fundamental role as an essential cofactor for two enzymes responsible for the production of succinyl-CoA and methionine. Vitamin B12 deficiency can occur in infants and may be related to the breastfeeding mother's adherence to a vegan diet or somatic diseases in the mother. It should be differentiated from inborn errors of vitamin B12 metabolism. Herein, we report the cases of three infants with West syndrome; all three were breastfed by mothers who followed a strict vegan diet. In one of the three infants, West syndrome developed during treatment with vitamin B12 and normalization of the vitamin B12 level. Early treatment and replacement therapy are worthwhile to prevent serious neurological problems and to improve the patient's clinical course.

Financial Support and Sponsorship

Nil.


Author Contributions

P.P., R.C., and R.F. diagnosed and followed the children; R. F., P. P., F.G., R.C., F.S., A.C., and A.C. reviewed the literature, critically discussed various aspects of epilepsy, and read the manuscript; P.P., R.C., A.C., R.F., F.G., F.S., and A.C. wrote the manuscript and prepared the tables.




Publication History

Received: 01 June 2020

Accepted: 18 January 2021

Article published online:
03 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Pavone P, Polizzi A, Marino SD. et al. West syndrome: a comprehensive review. Neurol Sci 2020; 41 (12) 3547-3562
  • 2 Gramer G, Fang-Hoffmann J, Feyh P. et al. Newborn screening for vitamin B12 deficiency in Germany-strategies, results, and public health implications. J Pediatr 2020; 216: 165-172.e4
  • 3 Irevall T, Axelsson I, Naumburg E. B12 deficiency is common in infants and is accompanied by serious neurological symptoms. Acta Paediatr 2017; 106 (01) 101-104
  • 4 Torsvik I, Ueland PM, Markestad T, Bjørke-Monsen AL. Cobalamin supplementation improves motor development and regurgitations in infants: results from a randomized intervention study. Am J Clin Nutr 2013; 98 (05) 1233-1240
  • 5 Chalouhi C, Faesch S, Anthoine-Milhomme MC, Fulla Y, Dulac O, Chéron G. Neurological consequences of vitamin B12 deficiency and its treatment. Pediatr Emerg Care 2008; 24 (08) 538-541
  • 6 Biancheri R, Cerone R, Schiaffino MC. et al. Cobalamin (Cbl) C/D deficiency: clinical, neurophysiological and neuroradiologic findings in 14 cases. Neuropediatrics 2001; 32 (01) 14-22
  • 7 Incecik F, Hergüner MO, Altunbaşak S, Leblebisatan G. Neurologic findings of nutritional vitamin B12 deficiency in children. Turk J Pediatr 2010; 52 (01) 17-21
  • 8 Taskesen M, Yaramis A, Pirinccioglu AG, Ekici F. Cranial magnetic resonance imaging findings of nutritional vitamin B12 deficiency in 15 hypotonic infants. Eur J Paediatr Neurol 2012; 16 (03) 266-270
  • 9 Demir N, Koc A, Üstyol L, Peker E, Abuhandan M. Clinical and neurological findings of severe vitamin B12 deficiency in infancy and importance of early diagnosis and treatment. J Paediatr Child Health 2013; 49 (10) 820-824
  • 10 Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clin Croat 2019; 58 (02) 295-302
  • 11 Meena MK, Sharma S, Bhasin H. et al. Vitamin B12 deficiency in children with infantile spasms: a case-control study. J Child Neurol 2018; 33 (12) 767-771
  • 12 Jadhav M, Webb JK, Vaishnava S, Baker SJ. Vitamin B12 deficiency in Indian infants. A clinical syndrome. Lancet 1962; 2 (7262): 903-907
  • 13 Erol I, Alehan F, Gümüs A. West syndrome in an infant with vitamin B12 deficiency in the absence of macrocytic anaemia. Dev Med Child Neurol 2007; 49 (10) 774-776
  • 14 Malbora B, Yuksel D, Aksoy A, Ozkan M. Two infants with infantile spasms associated with vitamin B12 deficiency. Pediatr Neurol 2014; 51 (01) 144-146
  • 15 Glaser K, Girschick HJ, Schropp C, Speer CP. Psychomotor development following early treatment of severe infantile vitamin B12 deficiency and West syndrome--is everything fine? A case report and review of literature. Brain Dev 2015; 37 (03) 347-351
  • 16 Chong PF, Matsukura M, Fukui K, Watanabe Y, Matsumoto N, Kira R. West syndrome in an infant with vitamin B12 deficiency born to autoantibodies positive mother. Front Pediatr 2019; 7: 531 DOI: 10.3389/fped.2019.00531.
  • 17 Lücke T, Korenke GC, Poggenburg I, Bentele KH, Das AM, Hartmann H. [Maternal vitamin B12 deficiency: cause for neurological symptoms in infancy]. Z Geburtshilfe Neonatol 2007; 211 (04) 157-161